F43 Psychiatric symptoms in huntington's disease: relationship to disease stage in the enroll-hd study. (September 2018)

• Record Type: Journal Article
• Authors: Chadwick, Helen; Owens, Rebecca; McMillan, Isobel; Howard, Elizabeth; Craufurd, David
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 89(2018)Supplement 1
• Page Start: A55
• Page End: A55
• Publication Date: 2018-09
• Subjects: Huntington's disease -- Behavioural phenotype -- Symptomatic treatment; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-EHDN.147
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Psychiatric symptoms are common in Huntington's disease (HD) and contribute significantly to functional impairment. Low mood, anxiety and irritability can all occur many years before motor onset, but are also common in the general population. Apathy and perseveration (repetitive thinking or behavior) can occur before motor onset, but usually appear after diagnosis and are worst from stage 3 onwards. A previous observational study of patients with early HD (TRACK-HD) found that apathy correlates with motor and cognitive measures of disease progression, while the mood disorder does not. Methods: We examined data collected in Manchester from the Enroll-HD observational study using a semi-structured psychiatric interview, the Problem Behaviours Assessment for HD (PBA-s), to investigate relationships between disease stage and psychiatric symptoms across the entire course from pre-symptomatic to advanced (Stage 4) disease, and in gene-negative controls. Results: In the gene-positive subjects (N=244), disease stage correlated strongly with apathy scores (rs=0.65, p<0.01) while there were weaker correlations with repetitive behaviours (rs=0.29, p<0.01) and modified total PBA-s score (mPBA) (rs=0.33, p<0.01). No significant correlations were found between disease stage and either affect or irritability scores. Significant differences were found between controls, pre-manifest and manifest subjects for apathy (Kruskall-Wallis test, H=117.0, p<0.01), repetitive behaviours (H=22.6, p<0.01) and mPBA scores (H=34.3, p<0.01) but not for affect or irritability scores. Conclusions: These findings replicate previous reports that apathy and perseveration correlate with disease stage, while disorders of mood (depression and anxiety) and irritability are more variable over time, and from person to person. This may reflect the complex aetiology of affective symptoms in HD, involving psychological variables and variation in genetic susceptibility as well as the disease itself. Alternatively, it is possible that successful symptomatic treatment of affective symptoms and irritability may be masking a true relationship with disease progression.